Adolescents' self-perceived and actual weight: Which plays a dominant role in weight loss behaviour in Lebanon?

BACKGROUND: The decision to lose weight among adolescents is complex and is guided by a number of body-related factors. This study examined the extent of agreement between actual weight, measured as body mass index, and self-perceived weight and assessed their relative importance in weight loss behaviour among Lebanese adolescents. METHODS: Data on 278 adolescents aged 13-17 years were drawn from the nationwide Nutrition and Non-Communicable Disease Risk Factor Survey (Lebanon, 2009). Binary multivariable logistic regressions were conducted to test associations with "effort to lose weight" as the outcome variable, controlling for a number of potential confounders. RESULTS: Close to 36% reported trying to lose weight. Around 21% and 13% were overweight and obese, respectively, and 40% and 10% perceived their weight as slightly high and very high, respectively. Inaccurate perceivers, those underestimating or overestimating their weight, constituted 39%, with overall percent agreement between actual and self-perceived weight being 60.8% (kappa statistic = 0.319, 95% CI [0.242, 0.396]). About a third of the overweight adolescents (30.5%) and more than half of the obese (56.8%) underestimated their weight. In the multivariable analysis, self-perceived weight was statistically significant and a stronger predictor of weight loss effort than body mass index (adjusted odds ratios = 14.42 and 6.42 for slightly high and very high perceived weight, respectively, compared to odds ratios = 1.47 and 2.31 for overweight and obese adolescents, respectively). CONCLUSION: Health professionals need to consider self-perceived weight in conjunction with actual weight in their pursuit of weight management goals and in planning prevention programmes that guide weight loss behaviours for adolescents.

Association between dietary patterns and the risk of metabolic syndrome among Lebanese adults.

PURPOSE: The main objective of this study was to evaluate the association between dietary patterns and the metabolic syndrome (MetS) and its metabolic abnormalities among Lebanese adults, using data from a national nutrition survey. METHODS: A cross-sectional analysis involving adults aged ≥ 18 years (n = 323) with no prior history of chronic diseases was conducted. Participants completed a brief sociodemographic and 61-item food frequency questionnaire. Anthropometric measurements and fasting blood samples were also obtained. The International Diabetes Federation criteria were used to classify study participants with the metabolic syndrome. Dietary patterns were identified by factor analysis. Multivariate logistic regression analysis was used to evaluate the associations of extracted patterns with MetS and its metabolic abnormalities. RESULTS: Out of 323 participants, 112 (34.6%) were classified as having MetS. Three dietary patterns were identified: "Fast Food/Dessert," "Traditional Lebanese," and "High Protein." Compared with participants in the lowest quintile of the Fast Food/Dessert pattern, those in the highest quintile had significantly higher odds for MetS (OR, 3.13; 95% CI: 1.36-7.22) and hyperglycemia (OR, 3.81; 95% CI: 159-9.14). Subjects with the highest intake of the High Protein pattern had an increased risk for hypertension (OR, 2.98; 95% CI: 1.26-7.02). The Traditional Lebanese pattern showed no association with MetS or its components. CONCLUSIONS: The findings of this study demonstrate a positive association of the Fast Food/Dessert pattern with MetS and hyperglycemia among Lebanese adults. These results may guide the development of improved preventive nutrition interventions in this adult population.

Complementary feeding in the MENA region: practices and challenges.

Suboptimal feeding patterns during the first two years of life are key determinants of malnutrition in children and constitute an important predictor of health in later years. Early-childhood nutritional factors, stunting, and obesity have been highlighted as prominent core underlying factors of Non-Communicable Disease (NCD) development whereas the improvement of complementary feeding practices has been cited as one of the most effective preventive strategies for reducing malnutrition and adult NCDs. In the MENA region NCD prevalence shows very high rates and the limited available studies show that current practices fall behind global recommendations. Common to all countries of this region are practices of mixed breast and bottle-feeding as early as the first month, as well as the premature introduction of complementary foods. Early introduction of non-milk fluids, such as sweetened water and herbal teas, has been described as a common practice in the region and the premature introduction of complementary foods has been reported in as high as 80% of infants in several of the countries. Thus, enhancing infant/young child health can significantly reduce morbidities and mortalities, as well as adult-onset diseases, ultimately decreasing the region's overall burden of disease.

Metabolic syndrome and insulin resistance in obese prepubertal children in Lebanon: a primary health concern.

BACKGROUND/AIMS: Ethnic-based associations between obesity and the metabolic syndrome (MS) have been suggested. The prevalence of MS in obese children was found to range between 13.9 and 48.8%, depending on the country of origin. This study was conducted to investigate the relationship between obesity and various components of MS in prepubertal children in Lebanon. METHODS: Eighty-seven obese children (Tanner stage 1), 25 overweight and 28 normal-weight controls were recruited from private and public schools. Anthropometric, biochemical and blood pressure measurements were performed. RESULTS: According to the modified Adult Treatment Panel III definition, the MS was identified in 26.4 and 4% of obese and overweight children, respectively, with a higher prevalence among girls than boys. The most common abnormalities among subjects with MS were elevated waist circumference (WC) (100.0%), high triglyceride (91.7%) and low high-density lipoprotein cholesterol (66.7%) levels. Insulin resistance was identified in 70% of obese children and 75% of those having the MS. Body mass index, WC and homeostasis model assessment of insulin resistance were significant determinants of the MS in this age group. CONCLUSION: MS was found in 26.4% of obese Lebanese children, thus underscoring the importance of early screening of obesity and its associated metabolic abnormalities and of developing successful multicomponent interventions addressing pediatric obesity and MS.

Adolescent obesity in Syria: prevalence and associated factors.

Abstract Background Data on the prevalence of overweight and obesity in Eastern Mediterranean countries remain scarce, particularly for children and adolescents. The objective of this study is to estimate the prevalence of obesity and examine associated factors and covariates amongst school adolescents in Syria. Methods A cross-sectional survey of a representative sample of 776 adolescents (386 males and 390 females), aged 15-18 years, was conducted in six randomly chosen secondary schools in Damascus, the capital city of Syria. Anthropometric measurements and dietary assessment data were collected using standard methods and techniques. Overweight and obesity were defined according to World Health Organization 2007 child growth standards. Results The prevalence rates of overweight and obesity were estimated at 18.9 and 8.6%, respectively. Carbohydrate and saturated fatty acid intakes were significantly higher amongst overweight and obese (250.66 and 32.82 g/day, respectively) as compared with normal weight adolescents (218.12 and 26.10 g/day, respectively). Regression analysis showed that the likelihood of obesity was significantly greater amongst adolescent boys than girls (OR = 2.30, P < 0.05) and amongst subjects reporting family history of obesity (OR = 2.98, P < 0.05). The odds of obesity increased consistently with increasing educational attainment of both parents and was higher (OR = 1.63) amongst adolescents reporting lower crowding index than their counterparts. Conclusion Our findings of a positive association between obesity and socio-economic status measured by parental education and crowding index call for intervention strategies for the promotion of healthy dietary practices not only amongst school adolescents but also parents, targeting families as the unit of intervention. Further studies are needed to examine nutritional habits and food choices amongst families of different socio-economic strata.

Activity concentrations and mean annual effective dose from gamma-emitting radionuclides in the Lebanese diet.

Since the primary factor contributing to the internal effective dose in the human organism is contaminated food, the control of radionuclides in food represents the most important means of protection. This study was conducted to determine the levels of the dietary exposure of the Lebanese population to gamma-emitting radioisotopes. The activity concentrations of gamma-emitting radioisotopes have been measured in food samples that represent the market basket of an adult urban population in Lebanon. The artificial radionuclide (137)Cs was measured above detection limits in only fish, meat and milk-based deserts. The most abundant natural radionuclide was 40K (31-121 Bq kg(-1)), with the highest content in fish and meat samples. The annual mean effective dose contributed by 40K in the reference typical diet was estimated equal to 186 microSv y(-1), a value reasonably consistent with findings reported by several other countries.

Food contamination by metals and pesticides in the European Union. Should we worry?

The estimation of the risk associated with dietary intakes of heavy metals and pesticide residues by the consumer is a vital and integral part of regulatory processes. The exposure of the consumer is compared directly to the acceptable daily intake (ADI) for pesticides and to the tolerable daily intake (TDI) for heavy metals. The exposure is obtained using the basic equation: Exposure (mg/kg b.w./day)=Consumption (mg/kg b.w./day) x Residue (mg/kg). The establishment of the ADI and the TDI is based on the results of toxicological studies that involve the determination of the lowest-no-observed-adverse-effect level/10 (SF1) x10 (SF2), where SF corresponds to 'Safety Factor'. SF1 and SF2 account for interspecies and intraspecies variability, respectively. In order to evaluate the risk for the consumer, that is associated to the presence of heavy metals and pesticides in food, a review of the level of contamination in European countries has been made. The exposure of European consumers to lead, cadmium, arsenic and mercury is superior to the TDI. For pesticides, the first step is to compare the detected amount of residues of a specific pesticide to the maximum residue level (MRL) authorized in foodstuffs. If the residue level in food exceeds the MRL, the theoretical maximum daily intakes and the ADI have to be taken into account in order to assess the risk for the consumer.

Dietary exposure to aflatoxins, ochratoxin A and deoxynivalenol from a total diet study in an adult urban Lebanese population.

Exposure to mycotoxins may be associated with carcinogenic, immunosuppressant and estrogenic effects. In the Middle-East, studies investigating food contamination and dietary exposure to mycotoxins are particularly scarce. This study aims at evaluating the dietary exposure of an adult Lebanese urban population to four mycotoxins (AFB1, AFM1, OTA, DON) classified as priority food contaminants by the WHO. Dietary exposure assessment was performed by means of the total diet study approach. Average and excessive consumer exposure estimates (p95) were calculated and compared with appropriate toxicological reference values (TRVs). Average dietary exposure levels to OTA and DON represented 29.9% and 156.8% of the respective TRVs, with the p95 exposure estimates approaching or exceeding the TRVs for these mycotoxins (95.1% and 355.8%, respectively). Based on the mean dietary exposure level to AFB1, cancer risk was estimated at 0.0527-0.0545cases/100,000persons/year, while mean exposure to AFM1 was associated with a population risk of 0.0018-0.0027cases/100,000persons/year. The study's findings place Lebanon among countries that are highly exposed to mycotoxins through the diet and call for larger-scale studies aiming at providing a comprehensive assessment of the dietary exposure of the Lebanese population to mycotoxins as well as to other food contaminants.

Validation of bioelectrical impedance analysis for total body water assessment against the deuterium dilution technique in Asian children.

BACKGROUND/OBJECTIVES: To develop and cross-validate bioelectrical impedance analysis (BIA) prediction equations of total body water (TBW) and fat-free mass (FFM) for Asian pre-pubertal children from China, Lebanon, Malaysia, Philippines and Thailand. SUBJECTS/METHODS: Height, weight, age, gender, resistance and reactance measured by BIA were collected from 948 Asian children (492 boys and 456 girls) aged 8-10 years from the five countries. The deuterium dilution technique was used as the criterion method for the estimation of TBW and FFM. The BIA equations were developed using stepwise multiple regression analysis and cross-validated using the Bland-Altman approach. RESULTS: The BIA prediction equation for the estimation of TBW was as follows: TBW=0.231 × height(2)/resistance+0.066 × height+0.188 × weight+0.128 × age+0.500 × sex-0.316 × Thais-4.574 (R (2)=88.0%, root mean square error (RMSE)=1.3 kg), and for the estimation of FFM was as follows: FFM=0.299 × height(2)/resistance+0.086 × height+0.245 × weight+0.260 × age+0.901 × sex-0.415 × ethnicity (Thai ethnicity =1, others = 0)-6.952 (R (2)=88.3%, RMSE=1.7 kg). No significant difference between measured and predicted values for the whole cross-validation sample was found. However, the prediction equation for estimation of TBW/FFM tended to overestimate TBW/FFM at lower levels whereas underestimate at higher levels of TBW/FFM. Accuracy of the general equation for TBW and FFM was also valid at each body mass index category. CONCLUSIONS: Ethnicity influences the relationship between BIA and body composition in Asian pre-pubertal children. The newly developed BIA prediction equations are valid for use in Asian pre-pubertal children.

Dietary exposure to essential and toxic trace elements from a Total diet study in an adult Lebanese urban population.

This study assesses, by the Total diet study approach, the adequacy of micronutrient intake (Co, Cu, Fe, Mn, Ni, Zn) and the dietary exposure of a Lebanese adult urban population to two toxic elements (Cd, Pb). The foods that made up the average 'total diet' were derived from a previous individual consumption survey. A total of 1215 individual foods were collected, prepared and cooked prior to analysis. Analytical quantification was performed using inductively coupled plasma mass spectrometry. Average daily intakes of Co (11.4 microg/day), Cu (1104.19 microg/day), Fe (13.00 mg/day), Mn (2.04 mg/day), Ni (126.27 microg/day) and Zn (10.97 mg/day) were below toxicological reference values and were found to satisfy nutritional recommendations, except for manganese in men and iron in women. Average dietary exposure to Pb and Cd represented 3.2% and 21.7% of the respective provisional tolerable weekly intakes. Estimates of dietary intakes of iron appeared to be inadequate for 63% of adult women. These findings should constitute a current measure of assessing the adequacy and safety of foods consumed in Lebanon and may be a basis for future monitoring studies.

Dietary exposure to lead, cadmium, mercury and radionuclides of an adult urban population in Lebanon: a total diet study approach.

Human exposure to toxic chemicals is suspected of being responsible for a wide range of human health disorders. This study is the first in Lebanon to evaluate the dietary exposure of an adult urban population to three heavy metals (lead, cadmium and mercury) and to radionuclides. Exposure assessment was performed by means of the total diet study approach as recommended by the Word Health Organization. Five 'total diets' were collected during 2003-04. Average and maximal consumer exposure estimates to heavy metals were calculated and compared with appropriate reference values and with intakes reported from other countries. The average dietary intakes of lead, cadmium and mercury represented 7, 17 and 5.6%, respectively, of the appropriate provisional tolerable weekly intakes (PTWI). The mean dietary intake of methylmercury represented 17.5% of the appropriate PTWI. Cs-134 and I-131 were not detected in any of the food samples. Traces of Cs-137 were only found in five food samples. The exposure assessment conducted places Lebanon among countries least exposed to heavy metals through the diet and it highlights the safety of the food supply from radioactive contamination.